Acute Care Surgery| Volume 286, P1-7, June 2023

Low-Dose Heparin Infusion as Venous Thromboembolism Chemoprophylaxis in Patients With Blunt Cerebrovascular Injury

Published:January 27, 2023DOI:



      Blunt cerebrovascular injury (BCVI) can result in devastating stroke. Because of operative inaccessibility, the most common treatment for BCVI is aspirin or a low-dose systemic heparin infusion. While it is assumed that low dose heparin infusion imparts venous thromboembolism (VTE) prophylaxis, this has not been evaluated in the BCVI population. The purpose of this study was to evaluate VTE rates in patients receiving low-dose heparin infusion as treatment for BCVI.


      Patients diagnosed with BCVI between 2014 and 2018 were reviewed for initiation of low-dose systemic heparin treatment. VTE was defined as a deep vein thrombosis or pulmonary embolism. BCVI patients without systemic heparin treatment were compared to BCVI patients with heparin treatment for overall VTE rates. Comparisons were also made to injured patients without a BCVI in our Trauma Activation Protocol (TAP) database.


      During the 5-year study period, 265 patients were identified with a BCVI. The majority (61%) were men with a median injury severity score (ISS) 22 (interquartile range [IQR]:14-33). Of these patients, 146 (55.1%) received a heparin infusion to treat BCVI. VTE was identified in eight of these patients (5.5%). Compared to TAP patients (n = 1020) who received standard dosing of VTE chemoprophylaxis, there was no difference in VTE rates compared to BCVI patients who were started on a low dose heparin infusion (3% versus 5.5%, P = 0.16). Area under the receiver operating characteristics (AUROC) was used to evaluate the predictive power of time to initiation of heparin infusion (AUC = 0.64 95% CI 0.42-0.85, P = 0.2) and time to reaching PTT goal (AUC = 0.52 95% CI 0.27-0.77, P = 0.83) as a predictor VTE events.


      Low dose heparin infusion is frequently used as an initial treatment of BCVI. In injured patients with BCVI, a low dose heparin infusion is associated with a low rate of VTE, comparable to injured patients without BCVI that received standard VTE chemoprophylaxis.


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        • Franz R.W.
        • Willette P.A.
        • Wood M.J.
        • Wright M.L.
        • Hartman J.F.
        A systematic review and meta-analysis of diagnostic screening criteria for blunt cerebrovascular injuries.
        J Am Coll Surg. 2012; 214: 313-327
        • Burlew C.C.
        • Sumislawski J.J.
        • Behnfield C.D.
        • et al.
        Time to stroke: a Western Trauma Association multicenter study of blunt cerebrovascular injuries.
        J Trauma Acute Care Surg. 2018; 85: 858-866
        • Cothren C.C.
        • Biffl W.L.
        • Moore E.E.
        • Kashuk J.L.
        • Johnson J.L.
        Treatment for blunt cerebrovascular injuries: equivalence of anticoagulation and antiplatelet agents.
        Arch Surg. 2009; 144: 685-690
        • McNutt M.K.
        • Kale A.C.
        • Kitagawa R.S.
        • et al.
        Management of blunt cerebrovascular injury (BCVI) in the multisystem injury patient with contraindications to immediate anti-thrombotic therapy.
        Injury. 2018; 49: 67-74
        • Shahan C.P.
        • Magnotti L.J.
        • McBeth P.B.
        • Weinberg J.A.
        • Croce M.A.
        • Fabian T.C.
        Early antithrombotic therapy is safe and effective in patients with blunt cerebrovascular injury and solid organ injury or traumatic brain injury.
        J Trauma Acute Care Surg. 2016; 81: 173-177
        • Shahan C.P.
        • Sharpe J.P.
        • Stickley S.M.
        • et al.
        The changing role of endovascular stenting for blunt cerebrovascular injuries.
        J Trauma Acute Care Surg. 2018; 84: 308-311
        • DiCocco J.M.
        • Fabian T.C.
        • Emmett K.P.
        • et al.
        Optimal outcomes for patients with blunt cerebrovascular injury (BCVI): tailoring treatment to the lesion.
        J Am Coll Surg. 2011; 212 (discussion 57-9): 549-557
        • Murphy P.B.
        • Severance S.
        • Holler E.
        • Menard L.
        • Savage S.
        • Zarzaur B.L.
        Treatment of asymptomatic blunt cerebrovascular injury (BCVI): a systematic review.
        Trauma Surg Acute Care Open. 2021; 6: e000668
        • Paffrath T.
        • Wafaisade A.
        • Lefering R.
        • et al.
        Venous thromboembolism after severe trauma: incidence, risk factors and outcome.
        Injury. 2010; 41: 97-101
        • Paydar S.
        • Sabetian G.
        • Khalili H.
        • et al.
        Management of deep vein thrombosis (DVT) prophylaxis in trauma patients.
        Bull Emerg Trauma. 2016; 4: 1-7
        • Piotrowski J.J.
        • Alexander J.J.
        • Brandt C.P.
        • McHenry C.R.
        • Yuhas J.P.
        • Jacobs D.
        Is deep vein thrombosis surveillance warranted in high-risk trauma patients?.
        Am J Surg. 1996; 172: 210-213
        • Rogers F.B.
        Venous thromboembolism in trauma patients: a review.
        Surgery. 2001; 130: 1-12
        • Moore H.B.
        • Moore E.E.
        • Neal M.D.
        • et al.
        Fibrinolysis shutdown in trauma: historical review and clinical implications.
        Anesth Analg. 2019; 129: 762-773
        • Lau B.D.
        • Murphy P.
        • Nastasi A.J.
        • et al.
        Effectiveness of ambulation to prevent venous thromboembolism in patients admitted to hospital: a systematic review.
        CMAJ Open. 2020; 8: E832-E843
        • Cohen A.T.
        • Berger S.E.
        • Milenkovic D.
        • Hill N.R.
        • Lister S.
        Anticoagulant selection for patients with VTE-Evidence from a systematic literature review of network meta-analyses.
        Pharm Res. 2019; 143: 166-177
        • Burlew C.C.
        • Biffl W.L.
        • Moore E.E.
        • Barnett C.C.
        • Johnson J.L.
        • Bensard D.D.
        Blunt cerebrovascular injuries: redefining screening criteria in the era of noninvasive diagnosis.
        J Trauma Acute Care Surg. 2012; 72 (discussion 6-7, quiz 539): 330-335
        • Biffl W.L.
        • Moore E.E.
        • Offner P.J.
        • Brega K.E.
        • Franciose R.J.
        • Burch J.M.
        Blunt carotid arterial injuries: implications of a new grading scale.
        J Trauma. 1999; 47: 845-853
        • Biffl W.L.
        • Moore E.E.
        • Ryu R.K.
        • et al.
        The unrecognized epidemic of blunt carotid arterial injuries: early diagnosis improves neurologic outcome.
        Ann Surg. 1998; 228: 462-470
        • Biffl W.L.
        • Moore E.E.
        • Offner P.J.
        • et al.
        Optimizing screening for blunt cerebrovascular injuries.
        Am J Surg. 1999; 178: 517-522
        • Shahan C.P.
        • Croce M.A.
        • Fabian T.C.
        • Magnotti L.J.
        Impact of continuous evaluation of technology and therapy: 30 years of research reduces stroke and mortality from blunt cerebrovascular injury.
        J Am Coll Surg. 2017; 224: 595-599
        • Paulus E.M.
        • Fabian T.C.
        • Savage S.A.
        • et al.
        Blunt cerebrovascular injury screening with 64-channel multidetector computed tomography: more slices finally cut it.
        J Trauma Acute Care Surg. 2014; 76 (discussion 84-5): 279-283
        • Wang P.
        • Kandemir U.
        • Zhang B.
        • et al.
        Incidence and risk factors of deep vein thrombosis in patients with pelvic and acetabular fractures.
        Clin Appl Thromb Hemost. 2019; 25 (1076029619845066)
        • Ley E.J.
        • Brown C.V.R.
        • Moore E.E.
        • et al.
        Updated guidelines to reduce venous thromboembolism in trauma patients: a Western Trauma Association critical decisions algorithm.
        J Trauma Acute Care Surg. 2020; 89: 971-981
        • Hereford T.
        • Thrush C.
        • Kimbrough M.K.
        Using injury severity score and abbreviated injury score to determine venous thromboembolism risk.
        Cureus. 2019; 11: e5977